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context F e r r e l G u i l l o r y
Director
guillory@ unc. edu
T h a d B e y l e
Associate Director
beyle@ email. unc. edu
H o d d i n g c a r t e r , III
Leadership Fellow
hoddingcarter@ unc. edu
K e n d r a D av e n p o r t C o tt o n
Assistant Director for Programs
kendradc@ unc. edu
A n d r ew h o lt o n
Assistant Director for Research
holton@ unc. edu
D . L e r o y T own s
Research Fellow
dltowns@ email. unc. edu
T h e P rogr am on Pub l i c L i f e
is a non- partisan organization dev-oted
to serving the people of North
Carolina and the South by informing
the public agenda and nurturing
leadership.
To receive an electronic version or to
subscribe to the printed version, send
your name and email address
to southnow@ unc. edu.
The Program on Public Life is part
of the Center for the Study of the
American South at the University
of North Carolina at Chapel Hill.
Carolina Context was printed with the
use of state funds. 750 copies of this
public document were printed at a
cost of $ 1,254, or $ 1.67 a copy.
w w w . s o u t h n o w . o r g o c t o b e r 2 0 0 6 N u m b e r 2
c a r o l i n a
t h e p r o g r a m o n p u b l i c l i f e
Director’s Note
In this second Carolina Context, we’ve
called upon the expertise of two UNC health
policy researchers.
Erin Fraher is Director of the North Caro-lina
Health Professions Data System at the Cecil
G. Sheps Center for Health Services Research at
the University of North Carolina at Chapel Hill
( UNC - CH ). Aaron McKethan is a Senior Associ-ate
at The Lewin Group in Falls Church, V. A. and
a Ph. D. candidate in Public Policy at UNC - CH .
Data in this report were compiled from the
U. S. Census Bureau, the NC State Data Center, the
Bureau of Labor Statistics and numerous allied
health workforce studies conducted by the Cecil
G. Sheps Center for Health Services Research in
collaboration with the Council for Allied Health
in North Carolina. Funding for these studies was
provided by the North Carolina Area Health Edu-cation
Center ( NC AHEC ) Program and The Duke
Endowment.
For additional reading on allied health, please
consult the following sources:
• Fraher, E. and McKethan, A. “ Lurching
from Oversupply to Shortage”, Journal of Al-lied
Health, under revision.
• Fraher, E. and McKethan A. “ The State of
Allied Health in North Carolina”, 2005, http://
www. shepscenter. unc. edu/ hp/
• McKethan, A. “ Health Care and Economic
Development: Five Critical Connections for
North Carolina,”, www. southnow. org
• Thaker, S. Fraher, E. and King, J. “ Allied
Health Job Vacancy Tracking Report, 2006” ,
http:// www. shepscenter. unc. edu/ hp/
• Gitterman, D., Spetz, J. and Fellowes M., “ The
Other Side of the Ledger: Federal Health Spend-ing
in Metropolitan Economies,” www. brookings.
edu/ metro/ pubs/ 20040917_ gitterman. htm
— Ferrel Guillory
Director, Program on Public Life
Findings
An analysis of allied health job opportunities across N orth C arolina shows that:
In the past 10 years, the health care and social assistance industries— of which allied health
is a subset— added 160,000 jobs to the state’s economy.
Rural counties in particular have experienced high rates of growth in health care and social
assistance employment, adding more than 100,000 jobs since 1990. We estimate that
more than one- third of these jobs have been in allied health.
The demand for allied health professions is likely to increase over time as the state’s popula-tion
continues to grow and the median age increases. In contrast to traditional manufactur-ing
industries, allied health care jobs represent a stable and growing employment sector.
Increased development of the state’s health care infrastructure will enhance economic
growth opportunities, particularly in areas attractive to retirees.
•
•
•
•
2 C a r o l i n a c o n t e x t
Si nce 1995, the state’s manufacturing employ-ment
has decreased by more than 30 percent.
Concurrently, as the state underwent a reces-sion,
the state’s poverty rate rose and more
people found themselves without health insur-ance.
Manufacturing has long served as a sta-ble
source of jobs for people and communities
across the state. However, since 1995, manu-facturing
employment in the state decreased
by more than 30%. Between 2000 and 2003,
North Carolina’s poverty rate increased by 1.7
percentage points, from 11.7% to 13.4%. During
the same period, the rate of uninsured North
Carolinians grew by 3.7 percentage points, from
13.6% to 17.3%.
While North Carolina has been particularly
hard hit by layoffs and downsizing in manufac-turing,
more North Carolinians are securing jobs
in health care and social assistance occupations.
( Figure 1) This sector is among the state’s larg-est
service industries and is also one of the fast-est-
growing. In the last 10 years, the health care
and social assistance industry added 160,000
jobs to the state’s economy. In 1995, this sector
accounted for fewer than 10% of total jobs in the
state; by 2005, that figure had climbed to 13%.
Rural areas have historically depended
more on manufacturing employment than have
urban areas. Between 1990 and 2005, North
Carolina’s rural counties experienced manu-facturing
job losses of 35%, compared to 28%
in non- rural counties. ( Figure 2) During this
same period, total job growth was more modest
in rural counties ( 6%) than in non- rural counties
( 16%). Yet, despite significant manufacturing
job loss and modest total job growth, rural coun-ties
have experienced strong growth in health
care and social assistance employment. Total
jobs in the industry nearly doubled since 1990,
adding over 100,000 jobs. While rural counties
continue to be relatively more dependent than
urban counties on manufacturing jobs, health
care and social assistance occupations now con-stitute
approximately 13 percent of total jobs in
both rural and non- rural parts of the state.
The rural story is echoed in the experiences
of both low- wealth and higher- wealth commu-nities
across the state. Economically- distressed
areas of the state have lost manufacturing jobs
more rapidly than other areas of the state, yet
these same communities have experienced
strong growth in health care and social assis-tance
employment. ( Figure 3) Counties in all
economic classifications have suffered signifi-cant
job loss in manufacturing, but Tier 1 and
Tier 2 counties ( the most economically dis-
Allied Health: Jobs for North Carolinians
Figure 2
Manufacturing and Health Care and Social Assistance Jobs in Rural versus
Urban Areas of N. C., 1990 and 2005
employment employment % % rate of
1990 2005 1990 2005 Growth
Manufacturing
Metro 377,937 273,729 21.8% 11.9% - 27.6%
Non- Metro 437,177 285,414 34.1% 18.9% - 34.7%
Health care and social asistance
Metro 153,892 283,535 8.9% 12.4% 84.2%
Non- Metro 106,725 207,558 8.3% 13.7% 94.5%
Source: Employment data are from the NC Employment Security Commission,
the North Carolina Rural Economic Development Center, Inc., Rural Data Bank
Source: North Carolina Employment Security Commission, 2006.
Figure 1
North Carolina Employment in Manufacturing
and Health Care & Social Assistance ( 1995- 2005)
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
900
800
700
600
500
400
300
200
100
0
Figure 3
Change in Manufacturing and Health Care
Employment in North Carolina by Economic
Classification ( 1995- 2005)
C hange in
E conomic C hange in C are & Social C hange in
C lassification manufacturing assistance t otal
(# of counties) E mployment E mployment E mployment
Tier 1 ( 20) - 49% 57% - 5%
Tier 2 ( 13) - 48% 45% - 9%
Tier 3 ( 33) - 35% 39% 3%
Tier 4 ( 16) - 29% 47% 9%
Tier 5 ( 18) - 20% 52% 24%
TOTAL STATE - 32% 48% 13%
Source: Employment data are from the NC Employment Security
Commission.
Manufacturing
Health Ca re & S ocial Assistance
Jobs in Thousands
C a r o l i n a c o n t e x t 3
Figure 4
Allied Health professions include
individuals who:
Perform x- rays, mammograms,
MRIs, and other imaging services
Perform lead and prostate cancer
marker screenings
Monitor individuals with liver
disease, diabetes, and leukemia
Provide speech, physical and
occupational therapy
Perform dental cleanings
Provide emergency medical services
( EMTs and paramedics)
Dispense prescriptions ( pharmacy
technicians)
Provide counseling services
Code and manage medical records
•
•
•
•
•
•
•
•
•
tressed) have experienced the greatest percent-age
loss of jobs, dropping by nearly half.
Driving Growth in Health Care
Employment
Strong growth in health care and social as-sistance
jobs has led to employment shortages
and skill gaps in the industry. While much at-tention
has been placed on job growth and labor
shortages in the health care industry, generally,
a particular subcategory of this industry faces
pronounced labor shortages and opportunities
for future growth— allied health.
Differing accounts of which professions fall
under the allied health umbrella abound; for
the purpose of this analysis, it includes health
care professionals with a wide range of creden-tials—
from high school graduates working as
pharmacy technicians in drug stores to physical
therapists with doctoral training. It can be easier
to conceptualize the breadth of professions fall-ing
under allied health by defining it as all health
care occupations except nurses, physicians, chi-ropractors,
dentists, optometrists, pharmacists
and podiatrists. ( Figure 4) Even when nurse
aides, orderlies, and attendants are excluded
from this definition, allied health jobs comprised
37% of total health care employment in North
Carolina in 2005. ( Figure 5)
Allied health jobs represent a large and in-creasingly
important employment sector in the
state and an engine for economic growth. More-over,
between 1999 and 2005, allied health em-ployment
in North Carolina grew by 46%. By
contrast, total health care employment grew at
less than half that rate ( 20%) and total employ-ment
in North Carolina increased just 0.2%.
( Figure 6) Nearly 70% of the total job growth
in the health care sector between 1999 and 2005
was due to growth of allied health jobs.
Unlike employment in traditional industries,
allied health jobs represent a stable employment
base because they are widely distributed across
the state and are less vulnerable to international
competition and economic recession. The vast
majority of allied health professions requires
direct, hands- on, patient care and is much less
likely to be outsourced to other locations. While
Allied Health Professions, 37%
Other, 3%*
Physicians, 5%
Licensed Practical Nurses, 5%
Total H ealthcare Jobs:
302,270
Source: U. S. Bureau of Labor Statistics, Occupational Employment Statistics ( 2005). * “ Other healthcare occupations” includes chiropractors, dentists, optometrists and pharmacists.
Figure 5
Healthcare Jobs in North Carolina, 2005
Registered Nurses, 26%
Nurse aides, orderlies and attendants, 24%
Figure 6
Total State, Healthcare and Allied Health Employment, North Carolina, 1999- 2005
4 C a r o l i n a c o n t e x t
group of allied health professions showed that
current demand for the therapy professions is
particularly strong. The report shows high va-cancy
rates for occupational therapy assistants,
physical therapists, occupational therapists and
physical therapist assistants. ( Figure 9) For
example, approximately 22 vacancies exist for
every 100 employed occupational therapy as-sistants.
To examine how the demand for the allied
health professions varied across the state, the
analysis assigned counties to Area Health Edu-cation
Center ( AHEC ) regions. North Carolina
is divided into nine AHEC regions. The nine re-gions
reflect rational clusters of counties within
which the area AHEC works to address concerns
related to the supply, distribution, retention and
quality of health professionals. The results in-dicate
that while the demand for allied health
professionals spans the state, eastern and south-eastern
counties of the state have the highest va-cancy
rates relative to population size.
One striking finding is the high percentage of
vacancy advertisements for emergency
medical personnel in eastern areas of
the state. ( Figure 10) More specifically,
29% of the vacancy advertisements col-lected
in Area L AHEC , 33% in Coastal
AHEC and 27% in Eastern AHEC
were for emergency medical techni-cians.
Demand for EMTs at specific
training levels ( basic, intermediate, or
paramedic) also varied by region of the
state. In three AHEC regions, the bulk
of the EMT ads were for basic- or inter-mediate-
trained personnel: Eastern,
Greensboro, and Southern Regional.
In the rest of the state, at least half of
EMT ads were for paramedics, the
most advanced level. ( Figure 11)
While vacancies in the allied health
fields present problems, the state has
shown strong capacity to train and
Figure 7
Hourly and Annual Wages for
Selected Allied Health Occupations
i n NC, 2 005
A nnual
H ourly M ean
O ccupation M ean Wage W age
Physicians $ 73.60 $ 153,072
RNs 24.99 51,970
Allied health professions 18.68 39,647
LPNs 16.80 34,940
Nursing aides, orderlies,
and attendants 9.85 20,500
North Carolina average wage $ 16.57 $ 34,460
Source: U. S. Bureau of Labor Statistics, Occupational
Employment Statistics ( 2005).
many entry- level allied health positions may not
provide the benefit packages historically offered
by manufacturing, wages for allied health jobs,
on average, are relatively competitive compared
to other health care professions and North Car-olina’s
average wage. ( Figure 7)
Demand for allied health professions is pro-jected
to increase rapidly over the next decade,
fueled in part by North Carolina’s growing and
aging population. Eight of the 10 fastest growing
occupations in the state ( across all industries and
all jobs) are allied health professions. ( Figure 8)
A recent study of vacancy rates for a select
Figure 8
North Carolina’s Fastest Growing Occupations
Percent Change in Employment 2002- 2012
P rojected %
Rank O ccupation O penings change
1 Medical Assistants 4,950 60.9
2 O ccupational Therapist Aides 30 60.0
3 D ental Hygienists 2,590 53.9
4 D ental Assistants 3,120 53.0
5 S ocial and Human Service Assistants
( includes a mix of allied health and
non- allied health personnel) 5,110 48.4
6 Medical Records and Health
Information Technicians 2,620 48.3
7 Physical Therapist Assistants 720 47.7
8 Fitness Trainers and Aerobics
Instructors ( not allied health) 2,780 47.6
9 R espiratory Therapy Technicians 330 47.1
10 R espiratory Therapists 1,170 46.8
Source: North Carolina Employment Security Commission
Figure 9
Vacancy Rate for Select Allied Health
Professions North Carolina, 2006
V acancies per 100
Profession employed professionals
Certified Occupational Therapy Assistant 21.8
Physical Therapist 17.4
Occupational Therapist 13.4
Physical Therapy Assistant 9.8
Speech- Language Pathologist 7.5
EMT ( Basic, Intermediate, Paramedic) 4.1
Radiologic Technologist / Technician 4.0
Med Technologist 1.7
Med Lab Technician 0.8
Source: Thaker, S. Fraher, E and King, J. “ Allied Health
Job Vacancy Tracking Report, 2006”
Source: Bureau of Labor Statistics. Occupational Employment Statistics.
State Cross- Industry Estimates: 1999- 2005.
350,0000
300,000
250,000
200,000
150,000
100,000
50,000
0
Health Care Jobs Allied Health Jobs
251,550 302,270 76,590 111,630
20.2%
45.8%
1999
2005
Growth Percentage
from 1999 to 2005
Total employment rose:
0.2%
From 3,801,670 in 1999
to 3,809,690 2005.
C a r o l i n a c o n t e x t 5
Indicates an accredited
Emergency Medical Technician
educational program
Source: North Carolina Allied Health Vacancy Tracking Project,
Cecil G. Sheps Center for Health Services Research, 2006.
Produced by: North Carolina Health Professions Data System,
Cecil G. Sheps Center for Health Services Research,
The University of North Carolina at Chapel Hill
Advertisements for Emergency Medical Technicians as a Percent of Total
Vacancy Advertisements by AHEC Region, North Carolina, 2006
Notes: North Carolina newspaper listings for select Allied Health
professions tracked from February 5 to April 23, 2006 ( N= 2060).
Sample excludes listings missing employer location ( N= 108) and
listings for which candidates with multiple degree types were eligible ( N= 78).
Mountain 13%
Area L 29%
Wake 9%
Charlotte 11%
Southern Regional 7%
Coastal 33%
Eastern 27%
Greensboro 11%
Northwest 7%
Figure 10
Allied Health Job Vacancy Advertisements per 10,000 Population by
AHEC Region, North Carolina, 2006
Source: North Carolina Allied Health Vacancy Tracking Project,
Cecil G. Sheps Center for Health Services Research, 2006.
Produced by: North Carolina Health Professions Data System,
Cecil G. Sheps Center for Health Services Research,
The University of North Carolina at Chapel Hill
Allied Health Job Vacancy Advertisements per 10,000 Population
by AHEC Region, North Carolina, 2006
Notes: North Carolina newspaper listings for select Allied Health
professions tracked from February 5 to April 23, 2006 ( N= 2060).
Sample excludes listings missing employer location ( N= 108) and
listings for which candidates with multiple degree types were eligible ( N= 78).
Vacancy advertisements per 10,000 population
2.9 to 3.7
2.1 to 2.8
1.5 to 2.0
Mountain 1.5
Area L
3.7
Wake
2.4
Charlotte 1.6
Southern Regional
3.4
Coastal 3.3
Eastern
2.3
Greensboro
Northwest 2.8
2.0
Figure 11
Advertisements for Emergency Medical Technicians as a Percent of
Total Vacancy Advertisements by AHEC Region, North Carolina, 2006
Source for Figure 10 and 11: North Carolina Allied Health Vacancy Tracking Project, Cecil G. Sheps Center for Health Services Research, 2006. Produced by: North Carolina Health Professions Data
System, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill.
Notes for Figure 10 and 11: North Carolina newspaper listings for select Allied Health Professions tracked from February 5 to April 23, 2006 ( N= 2060). Sample excludes listings missing employer loca-tion
( N= 108) and listings for which candidates with multiple degree types were eligible ( N= 78).
6 C a r o l i n a c o n t e x t
retain allied health workers. Approximately,
eighty- five percent of individuals enrolled in al-lied
health education programs in the state are
trained through the North Carolina Community
College System. In addition, data show that re-tention
rates for allied health students trained in
N. C. range from 54% to 86%, with most profes-sions
retaining around three quarters of students
within the state after graduation. ( Figure 12)
An Aging Population Creates
Opportunity
The need for allied health workers will only
increase as the number of older residents in-creases,
fueling greater demand for health ser-vices.
Some experts estimate the percentage of
U. S. gross domestic product spent on health care
will rise from 16% to 25% by 2030. Within North
Carolina, the number of residents 65 and over
is projected to grow from 980,000 in 2000 to
2,200,000 in 2030. Such growth is projected to
be especially rapid in the mountain and coastal
counties.
The demand for health care services will in-
WWWWWWWWaaaaaaaarrrrrrrrrrrrrrrreeeeeeeennnnnnnn HHHHeeeerrrrtttfftffoooorrrrdddd
Camden
Currituck
miles
Total Enrollment in Allied Health Programs**
(# of Counties)
500 or More ( 8)
200 to 499 ( 13)
100 to 199 ( 16)
Less than 100 ( 21)
No allied health programs available in county ( 42)
Location of Allied Health Programs* and
Total Enrollment in Allied Health Programs,
North Carolina Community Colleges and University Programs, 2004
Produced By: The North Carolina Health Professions Data System, Cecil G. Sheps
Center for Health Services Research, The University of North Carolina at Chapel Hill.
Location of Community College
Location of University Program
Source: North Carolina Community College System, 2004; University Programs, 2005.
no students enrolled for past three years. Enrollment data were unavailable for programs
at Lenoir- Rhyne College in Catawba County.
* Locations of community colleges and universities are mapped to the zip code centroid.
** Enrollment of each community college is mapped to the county where the community
college is located. Sampson CC and Craven CC have allied health programs, but no
Stokes
Surry
Yadkin
Iredell
Davie
Stanly
Union
Cabarrus
Rowan
Alamance
Davidson
Rockingham
Guilford
Chatham
Montgomery
Hoke
Moore
Lee
Randolph
Richmond
Scotland
Robeson
Vance
Caswell
Person
Granville
Durham
Orange
Wake
Harnett
Franklin
Cumberland
Bladen
Warren
Johnston
Sampson
Jones
Pender
Duplin
Onslow
Lenoir
Wayne
Greene
Wilson
Halifax
Nash
Edgecombe
Bertie
Pitt
Hertford
Northampton
Martin
Hyde
Beaufort
Craven
Pamlico
Carteret
Perquimans
Washington
Pasquotank
Chowan
Gates
Dare
Tyrrell
Anson
Columbus
Brunswick
New
Hanover
Cherokee
Clay
Graham
Swain
Macon
Haywood
Madison
Transylvania
Jackson
Mitchell
Yancey
Polk
Henderson
Buncombe
Avery
McDowell
Rutherford
Watauga
Caldwell
Ashe
Wilkes
Alleghany
Alexander
Lincoln
Gaston
Catawba
Cleveland
Burke
Mecklenburg
Forsyth
crease as the population ages because utilization
of services typically increases with age. Thus,
communities with a high proportion of older
residents are more likely to experience increased
demand for health care services over time. ( Fig-ure
13)
The increase in health care demand will cre-ate
significant economic development opportu-nities
within the state— both due to the aging of
baby boomers already living in North Carolina
and to the influx of new residents. In 2004, 17
North Carolina counties were designated as “ re-tirement
destinations” by the U. S. Department
of Agriculture’s Economic Research Service.
Avery County, in northwest North Carolina,
has seen a rapid growth in health care employ-ment
to fill demand for health care and related
services. Cannon Memorial Hospital is Avery
County’s largest employer, with more than 500
employees.
In retirement communities, the flow of
Medicare and other health care expenditures
to providers have an important impact on local
jobs and health revenue. Health care expendi-tures
by Medicare, Medicaid, and other payers
are distributed to health care providers ( e. g.,
hospitals, physicians, clinics, pharmacies) in
exchange for medical services provided. For ex-ample,
in 2004 North Carolina spent more than
$ 6.8 billion in federally funded Medicare expen-ditures.
These funds represent a major source
of revenue for health care providers and are a
key factor in funding health care jobs. Using the
Avery County example, Cannon Memorial Hos-pital
attributes more than 70% of its inpatient
revenue to Medicare.
North Carolina’s temperate climate and ac-cess
to recreation have been key factors in the
state becoming a magnet for retirees. Yet to
realize the economic development potential
created by the influx of retirees, the state must
maintain and further develop a strong health
care infrastructure.
What’s Needed: Coordination
Allied health employment in North Carolina is
expected to increase, and the state faces high va-cancy
rates in some professions. Vacancy rates are
Figure 12
Location of Allied Health Programs* and Total Enrollment in Allied
Health Programs, North Carolina Community Colleges and University
Programs, 2004
Source: North Carolina Community College System, 2004; University Programs, 2005. Produced by: The North Carolina Health
Professions Data System, Cecil G. Sheps Center for Health Services Research, Thu University of North Carolina at Chapel Hill.
Notes: Locations of community colleges and universities are mapped to the zip code centroid. Enrollment of each community
college is mapped to the county where the community college is located. Sampson CC and Craven CC have allied health
programs, but no students enrolled for past three years. Enrollment data were unavailable for the program at Lenoir- Rhyne
College in Catawba County.
C a r o l i n a c o n t e x t 7
generally higher in rural, eastern North Carolina.
Without coordinated action, allied health
workforce development efforts become frag-mented
because of limited collaboration be-tween
policy makers, employers, educators and
others charged with monitoring, planning and
implementing workforce strategies at the lo-cal
or state level. Workforce shortages are not
unique to individual employers or regions of the
state, and the responsibility for ameliorating
these shortages does not rest on the shoulders
of individual entities. Thus, policy interventions
aimed at coordinating a synergistic response has
the potential to yield high benefits.
Developing a well- coordinated allied health
infrastructure presents a number of challenges:
• Growth in the health services economy
has benefits as well as burdens. Relative to de-clining
manufacturing jobs, many entry- level
allied health jobs are low- paying and/ or don’t
come with benefits; higher paying jobs require
more extensive training.
• Many health jobs do not have opportu-nities
for career laddering. Opportunities to
promote workers from entry- level jobs ( i. e.
occupational therapy assistant positions) into
more advanced jobs ( occupational therapist
jobs) do not exist. An important challenge
that workforce and health care planners face
is creating opportunities for career laddering
from entry- level positions to these higher-skill,
higher- wage positions, which enable the
worker to continue working ( and earning
income) during the process.
Despite strong demand for allied health
workers, many educational programs are under-enrolled
or face a shortage of adequately pre-pared
applicants.
Attrition from education programs is a ma-jor
issue confronting the allied health workforce
and is costly both to the educational system and
students.
Faculty recruitment and retention issues
are common for most allied health professions,
particularly those facing shortages, because fac-ulty
salaries cannot compete with clinical sala-ries.
A related issue is that many allied health
professions are facing increased accreditation
standards that require faculty to hold advanced
degrees. While this change improves the quality
of faculty who are teaching future practitioners,
it also contributes to faculty shortages. Faculty
who do not want to pursue additional education
may instead choose to retire or return to clinical
practice. Faculty shortages constrict future sup-ply
by reducing the number of individuals able to
teach courses and supervise clinical placements.
Future Opportunities
Research has shown that investments in
educating allied health workers pay short- term
dividends because the vast majority of these
professionals are trained through the local com-munity
college system and they tend to stay in-state,
near to where they were trained. Thus,
the combination of strong growth rates in allied
health employment and high retention rates for
students creates opportunities for state policy
makers to increase access to employment and
improve access to health care services across the
state, particularly in rural areas. Another ben-efit
from developing a more comprehensive and
concerted connection between economic devel-opment
and workforce development strategies
is the potential to help workers who have been
displaced from traditional industries into allied
health care employment. To accomplish this
goal, the following issues must be addressed:
• Create opportunities for better collabo-ration
between health workforce entities ( i. e.
the educational system, professional associa-tions,
employers) and workforce development
boards
• Target specific health care professions
and/ or regions of the state for allied health
workforce development
• Identify “ best practices”— support and
duplicate statewide:
Innovative programs to reduce attrition
from community college programs
Distance learning and multi- institution
collaborative educational programs
Career laddering opportunities: i. e.
articulation agreements and collabora-tion
between certificate, two- year and
four- year educational programs.
• Improve data collection efforts on the al-lied
health workforce so that we have a better
understanding of where existing and future
shortages exist.
•
•
•
Figure 13
Ambulatory Care Visits to Physician Offices and Clinics
per 100 Persons, United States, 2004
Source: NAMCS, 2004. Advance Data No. 374, June 23, 2006.
Note: Visit rates for age, sex, race, and ethnicity are based on the July 1, 2004, set of estimates of the
civilian noninstitutional population of the United States as developed by the Population Division, U. S.
Census Bureau.
800
700
600
500
400
300
200
100
0
1- 4 years 5- 14 years 15- 24 years 25- 44 years 45- 64 years 65- 74 years 75 years
or older
Visits per 100 persons per year
278.3 187.1 173.8 238.6 378.2 622.6 733.8
Age
Total Visits= 810,867;
316.8 visits per 100
persons

context F e r r e l G u i l l o r y
Director
guillory@ unc. edu
T h a d B e y l e
Associate Director
beyle@ email. unc. edu
H o d d i n g c a r t e r , III
Leadership Fellow
hoddingcarter@ unc. edu
K e n d r a D av e n p o r t C o tt o n
Assistant Director for Programs
kendradc@ unc. edu
A n d r ew h o lt o n
Assistant Director for Research
holton@ unc. edu
D . L e r o y T own s
Research Fellow
dltowns@ email. unc. edu
T h e P rogr am on Pub l i c L i f e
is a non- partisan organization dev-oted
to serving the people of North
Carolina and the South by informing
the public agenda and nurturing
leadership.
To receive an electronic version or to
subscribe to the printed version, send
your name and email address
to southnow@ unc. edu.
The Program on Public Life is part
of the Center for the Study of the
American South at the University
of North Carolina at Chapel Hill.
Carolina Context was printed with the
use of state funds. 750 copies of this
public document were printed at a
cost of $ 1,254, or $ 1.67 a copy.
w w w . s o u t h n o w . o r g o c t o b e r 2 0 0 6 N u m b e r 2
c a r o l i n a
t h e p r o g r a m o n p u b l i c l i f e
Director’s Note
In this second Carolina Context, we’ve
called upon the expertise of two UNC health
policy researchers.
Erin Fraher is Director of the North Caro-lina
Health Professions Data System at the Cecil
G. Sheps Center for Health Services Research at
the University of North Carolina at Chapel Hill
( UNC - CH ). Aaron McKethan is a Senior Associ-ate
at The Lewin Group in Falls Church, V. A. and
a Ph. D. candidate in Public Policy at UNC - CH .
Data in this report were compiled from the
U. S. Census Bureau, the NC State Data Center, the
Bureau of Labor Statistics and numerous allied
health workforce studies conducted by the Cecil
G. Sheps Center for Health Services Research in
collaboration with the Council for Allied Health
in North Carolina. Funding for these studies was
provided by the North Carolina Area Health Edu-cation
Center ( NC AHEC ) Program and The Duke
Endowment.
For additional reading on allied health, please
consult the following sources:
• Fraher, E. and McKethan, A. “ Lurching
from Oversupply to Shortage”, Journal of Al-lied
Health, under revision.
• Fraher, E. and McKethan A. “ The State of
Allied Health in North Carolina”, 2005, http://
www. shepscenter. unc. edu/ hp/
• McKethan, A. “ Health Care and Economic
Development: Five Critical Connections for
North Carolina,”, www. southnow. org
• Thaker, S. Fraher, E. and King, J. “ Allied
Health Job Vacancy Tracking Report, 2006” ,
http:// www. shepscenter. unc. edu/ hp/
• Gitterman, D., Spetz, J. and Fellowes M., “ The
Other Side of the Ledger: Federal Health Spend-ing
in Metropolitan Economies,” www. brookings.
edu/ metro/ pubs/ 20040917_ gitterman. htm
— Ferrel Guillory
Director, Program on Public Life
Findings
An analysis of allied health job opportunities across N orth C arolina shows that:
In the past 10 years, the health care and social assistance industries— of which allied health
is a subset— added 160,000 jobs to the state’s economy.
Rural counties in particular have experienced high rates of growth in health care and social
assistance employment, adding more than 100,000 jobs since 1990. We estimate that
more than one- third of these jobs have been in allied health.
The demand for allied health professions is likely to increase over time as the state’s popula-tion
continues to grow and the median age increases. In contrast to traditional manufactur-ing
industries, allied health care jobs represent a stable and growing employment sector.
Increased development of the state’s health care infrastructure will enhance economic
growth opportunities, particularly in areas attractive to retirees.
•
•
•
•
2 C a r o l i n a c o n t e x t
Si nce 1995, the state’s manufacturing employ-ment
has decreased by more than 30 percent.
Concurrently, as the state underwent a reces-sion,
the state’s poverty rate rose and more
people found themselves without health insur-ance.
Manufacturing has long served as a sta-ble
source of jobs for people and communities
across the state. However, since 1995, manu-facturing
employment in the state decreased
by more than 30%. Between 2000 and 2003,
North Carolina’s poverty rate increased by 1.7
percentage points, from 11.7% to 13.4%. During
the same period, the rate of uninsured North
Carolinians grew by 3.7 percentage points, from
13.6% to 17.3%.
While North Carolina has been particularly
hard hit by layoffs and downsizing in manufac-turing,
more North Carolinians are securing jobs
in health care and social assistance occupations.
( Figure 1) This sector is among the state’s larg-est
service industries and is also one of the fast-est-
growing. In the last 10 years, the health care
and social assistance industry added 160,000
jobs to the state’s economy. In 1995, this sector
accounted for fewer than 10% of total jobs in the
state; by 2005, that figure had climbed to 13%.
Rural areas have historically depended
more on manufacturing employment than have
urban areas. Between 1990 and 2005, North
Carolina’s rural counties experienced manu-facturing
job losses of 35%, compared to 28%
in non- rural counties. ( Figure 2) During this
same period, total job growth was more modest
in rural counties ( 6%) than in non- rural counties
( 16%). Yet, despite significant manufacturing
job loss and modest total job growth, rural coun-ties
have experienced strong growth in health
care and social assistance employment. Total
jobs in the industry nearly doubled since 1990,
adding over 100,000 jobs. While rural counties
continue to be relatively more dependent than
urban counties on manufacturing jobs, health
care and social assistance occupations now con-stitute
approximately 13 percent of total jobs in
both rural and non- rural parts of the state.
The rural story is echoed in the experiences
of both low- wealth and higher- wealth commu-nities
across the state. Economically- distressed
areas of the state have lost manufacturing jobs
more rapidly than other areas of the state, yet
these same communities have experienced
strong growth in health care and social assis-tance
employment. ( Figure 3) Counties in all
economic classifications have suffered signifi-cant
job loss in manufacturing, but Tier 1 and
Tier 2 counties ( the most economically dis-
Allied Health: Jobs for North Carolinians
Figure 2
Manufacturing and Health Care and Social Assistance Jobs in Rural versus
Urban Areas of N. C., 1990 and 2005
employment employment % % rate of
1990 2005 1990 2005 Growth
Manufacturing
Metro 377,937 273,729 21.8% 11.9% - 27.6%
Non- Metro 437,177 285,414 34.1% 18.9% - 34.7%
Health care and social asistance
Metro 153,892 283,535 8.9% 12.4% 84.2%
Non- Metro 106,725 207,558 8.3% 13.7% 94.5%
Source: Employment data are from the NC Employment Security Commission,
the North Carolina Rural Economic Development Center, Inc., Rural Data Bank
Source: North Carolina Employment Security Commission, 2006.
Figure 1
North Carolina Employment in Manufacturing
and Health Care & Social Assistance ( 1995- 2005)
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
900
800
700
600
500
400
300
200
100
0
Figure 3
Change in Manufacturing and Health Care
Employment in North Carolina by Economic
Classification ( 1995- 2005)
C hange in
E conomic C hange in C are & Social C hange in
C lassification manufacturing assistance t otal
(# of counties) E mployment E mployment E mployment
Tier 1 ( 20) - 49% 57% - 5%
Tier 2 ( 13) - 48% 45% - 9%
Tier 3 ( 33) - 35% 39% 3%
Tier 4 ( 16) - 29% 47% 9%
Tier 5 ( 18) - 20% 52% 24%
TOTAL STATE - 32% 48% 13%
Source: Employment data are from the NC Employment Security
Commission.
Manufacturing
Health Ca re & S ocial Assistance
Jobs in Thousands
C a r o l i n a c o n t e x t 3
Figure 4
Allied Health professions include
individuals who:
Perform x- rays, mammograms,
MRIs, and other imaging services
Perform lead and prostate cancer
marker screenings
Monitor individuals with liver
disease, diabetes, and leukemia
Provide speech, physical and
occupational therapy
Perform dental cleanings
Provide emergency medical services
( EMTs and paramedics)
Dispense prescriptions ( pharmacy
technicians)
Provide counseling services
Code and manage medical records
•
•
•
•
•
•
•
•
•
tressed) have experienced the greatest percent-age
loss of jobs, dropping by nearly half.
Driving Growth in Health Care
Employment
Strong growth in health care and social as-sistance
jobs has led to employment shortages
and skill gaps in the industry. While much at-tention
has been placed on job growth and labor
shortages in the health care industry, generally,
a particular subcategory of this industry faces
pronounced labor shortages and opportunities
for future growth— allied health.
Differing accounts of which professions fall
under the allied health umbrella abound; for
the purpose of this analysis, it includes health
care professionals with a wide range of creden-tials—
from high school graduates working as
pharmacy technicians in drug stores to physical
therapists with doctoral training. It can be easier
to conceptualize the breadth of professions fall-ing
under allied health by defining it as all health
care occupations except nurses, physicians, chi-ropractors,
dentists, optometrists, pharmacists
and podiatrists. ( Figure 4) Even when nurse
aides, orderlies, and attendants are excluded
from this definition, allied health jobs comprised
37% of total health care employment in North
Carolina in 2005. ( Figure 5)
Allied health jobs represent a large and in-creasingly
important employment sector in the
state and an engine for economic growth. More-over,
between 1999 and 2005, allied health em-ployment
in North Carolina grew by 46%. By
contrast, total health care employment grew at
less than half that rate ( 20%) and total employ-ment
in North Carolina increased just 0.2%.
( Figure 6) Nearly 70% of the total job growth
in the health care sector between 1999 and 2005
was due to growth of allied health jobs.
Unlike employment in traditional industries,
allied health jobs represent a stable employment
base because they are widely distributed across
the state and are less vulnerable to international
competition and economic recession. The vast
majority of allied health professions requires
direct, hands- on, patient care and is much less
likely to be outsourced to other locations. While
Allied Health Professions, 37%
Other, 3%*
Physicians, 5%
Licensed Practical Nurses, 5%
Total H ealthcare Jobs:
302,270
Source: U. S. Bureau of Labor Statistics, Occupational Employment Statistics ( 2005). * “ Other healthcare occupations” includes chiropractors, dentists, optometrists and pharmacists.
Figure 5
Healthcare Jobs in North Carolina, 2005
Registered Nurses, 26%
Nurse aides, orderlies and attendants, 24%
Figure 6
Total State, Healthcare and Allied Health Employment, North Carolina, 1999- 2005
4 C a r o l i n a c o n t e x t
group of allied health professions showed that
current demand for the therapy professions is
particularly strong. The report shows high va-cancy
rates for occupational therapy assistants,
physical therapists, occupational therapists and
physical therapist assistants. ( Figure 9) For
example, approximately 22 vacancies exist for
every 100 employed occupational therapy as-sistants.
To examine how the demand for the allied
health professions varied across the state, the
analysis assigned counties to Area Health Edu-cation
Center ( AHEC ) regions. North Carolina
is divided into nine AHEC regions. The nine re-gions
reflect rational clusters of counties within
which the area AHEC works to address concerns
related to the supply, distribution, retention and
quality of health professionals. The results in-dicate
that while the demand for allied health
professionals spans the state, eastern and south-eastern
counties of the state have the highest va-cancy
rates relative to population size.
One striking finding is the high percentage of
vacancy advertisements for emergency
medical personnel in eastern areas of
the state. ( Figure 10) More specifically,
29% of the vacancy advertisements col-lected
in Area L AHEC , 33% in Coastal
AHEC and 27% in Eastern AHEC
were for emergency medical techni-cians.
Demand for EMTs at specific
training levels ( basic, intermediate, or
paramedic) also varied by region of the
state. In three AHEC regions, the bulk
of the EMT ads were for basic- or inter-mediate-
trained personnel: Eastern,
Greensboro, and Southern Regional.
In the rest of the state, at least half of
EMT ads were for paramedics, the
most advanced level. ( Figure 11)
While vacancies in the allied health
fields present problems, the state has
shown strong capacity to train and
Figure 7
Hourly and Annual Wages for
Selected Allied Health Occupations
i n NC, 2 005
A nnual
H ourly M ean
O ccupation M ean Wage W age
Physicians $ 73.60 $ 153,072
RNs 24.99 51,970
Allied health professions 18.68 39,647
LPNs 16.80 34,940
Nursing aides, orderlies,
and attendants 9.85 20,500
North Carolina average wage $ 16.57 $ 34,460
Source: U. S. Bureau of Labor Statistics, Occupational
Employment Statistics ( 2005).
many entry- level allied health positions may not
provide the benefit packages historically offered
by manufacturing, wages for allied health jobs,
on average, are relatively competitive compared
to other health care professions and North Car-olina’s
average wage. ( Figure 7)
Demand for allied health professions is pro-jected
to increase rapidly over the next decade,
fueled in part by North Carolina’s growing and
aging population. Eight of the 10 fastest growing
occupations in the state ( across all industries and
all jobs) are allied health professions. ( Figure 8)
A recent study of vacancy rates for a select
Figure 8
North Carolina’s Fastest Growing Occupations
Percent Change in Employment 2002- 2012
P rojected %
Rank O ccupation O penings change
1 Medical Assistants 4,950 60.9
2 O ccupational Therapist Aides 30 60.0
3 D ental Hygienists 2,590 53.9
4 D ental Assistants 3,120 53.0
5 S ocial and Human Service Assistants
( includes a mix of allied health and
non- allied health personnel) 5,110 48.4
6 Medical Records and Health
Information Technicians 2,620 48.3
7 Physical Therapist Assistants 720 47.7
8 Fitness Trainers and Aerobics
Instructors ( not allied health) 2,780 47.6
9 R espiratory Therapy Technicians 330 47.1
10 R espiratory Therapists 1,170 46.8
Source: North Carolina Employment Security Commission
Figure 9
Vacancy Rate for Select Allied Health
Professions North Carolina, 2006
V acancies per 100
Profession employed professionals
Certified Occupational Therapy Assistant 21.8
Physical Therapist 17.4
Occupational Therapist 13.4
Physical Therapy Assistant 9.8
Speech- Language Pathologist 7.5
EMT ( Basic, Intermediate, Paramedic) 4.1
Radiologic Technologist / Technician 4.0
Med Technologist 1.7
Med Lab Technician 0.8
Source: Thaker, S. Fraher, E and King, J. “ Allied Health
Job Vacancy Tracking Report, 2006”
Source: Bureau of Labor Statistics. Occupational Employment Statistics.
State Cross- Industry Estimates: 1999- 2005.
350,0000
300,000
250,000
200,000
150,000
100,000
50,000
0
Health Care Jobs Allied Health Jobs
251,550 302,270 76,590 111,630
20.2%
45.8%
1999
2005
Growth Percentage
from 1999 to 2005
Total employment rose:
0.2%
From 3,801,670 in 1999
to 3,809,690 2005.
C a r o l i n a c o n t e x t 5
Indicates an accredited
Emergency Medical Technician
educational program
Source: North Carolina Allied Health Vacancy Tracking Project,
Cecil G. Sheps Center for Health Services Research, 2006.
Produced by: North Carolina Health Professions Data System,
Cecil G. Sheps Center for Health Services Research,
The University of North Carolina at Chapel Hill
Advertisements for Emergency Medical Technicians as a Percent of Total
Vacancy Advertisements by AHEC Region, North Carolina, 2006
Notes: North Carolina newspaper listings for select Allied Health
professions tracked from February 5 to April 23, 2006 ( N= 2060).
Sample excludes listings missing employer location ( N= 108) and
listings for which candidates with multiple degree types were eligible ( N= 78).
Mountain 13%
Area L 29%
Wake 9%
Charlotte 11%
Southern Regional 7%
Coastal 33%
Eastern 27%
Greensboro 11%
Northwest 7%
Figure 10
Allied Health Job Vacancy Advertisements per 10,000 Population by
AHEC Region, North Carolina, 2006
Source: North Carolina Allied Health Vacancy Tracking Project,
Cecil G. Sheps Center for Health Services Research, 2006.
Produced by: North Carolina Health Professions Data System,
Cecil G. Sheps Center for Health Services Research,
The University of North Carolina at Chapel Hill
Allied Health Job Vacancy Advertisements per 10,000 Population
by AHEC Region, North Carolina, 2006
Notes: North Carolina newspaper listings for select Allied Health
professions tracked from February 5 to April 23, 2006 ( N= 2060).
Sample excludes listings missing employer location ( N= 108) and
listings for which candidates with multiple degree types were eligible ( N= 78).
Vacancy advertisements per 10,000 population
2.9 to 3.7
2.1 to 2.8
1.5 to 2.0
Mountain 1.5
Area L
3.7
Wake
2.4
Charlotte 1.6
Southern Regional
3.4
Coastal 3.3
Eastern
2.3
Greensboro
Northwest 2.8
2.0
Figure 11
Advertisements for Emergency Medical Technicians as a Percent of
Total Vacancy Advertisements by AHEC Region, North Carolina, 2006
Source for Figure 10 and 11: North Carolina Allied Health Vacancy Tracking Project, Cecil G. Sheps Center for Health Services Research, 2006. Produced by: North Carolina Health Professions Data
System, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill.
Notes for Figure 10 and 11: North Carolina newspaper listings for select Allied Health Professions tracked from February 5 to April 23, 2006 ( N= 2060). Sample excludes listings missing employer loca-tion
( N= 108) and listings for which candidates with multiple degree types were eligible ( N= 78).
6 C a r o l i n a c o n t e x t
retain allied health workers. Approximately,
eighty- five percent of individuals enrolled in al-lied
health education programs in the state are
trained through the North Carolina Community
College System. In addition, data show that re-tention
rates for allied health students trained in
N. C. range from 54% to 86%, with most profes-sions
retaining around three quarters of students
within the state after graduation. ( Figure 12)
An Aging Population Creates
Opportunity
The need for allied health workers will only
increase as the number of older residents in-creases,
fueling greater demand for health ser-vices.
Some experts estimate the percentage of
U. S. gross domestic product spent on health care
will rise from 16% to 25% by 2030. Within North
Carolina, the number of residents 65 and over
is projected to grow from 980,000 in 2000 to
2,200,000 in 2030. Such growth is projected to
be especially rapid in the mountain and coastal
counties.
The demand for health care services will in-
WWWWWWWWaaaaaaaarrrrrrrrrrrrrrrreeeeeeeennnnnnnn HHHHeeeerrrrtttfftffoooorrrrdddd
Camden
Currituck
miles
Total Enrollment in Allied Health Programs**
(# of Counties)
500 or More ( 8)
200 to 499 ( 13)
100 to 199 ( 16)
Less than 100 ( 21)
No allied health programs available in county ( 42)
Location of Allied Health Programs* and
Total Enrollment in Allied Health Programs,
North Carolina Community Colleges and University Programs, 2004
Produced By: The North Carolina Health Professions Data System, Cecil G. Sheps
Center for Health Services Research, The University of North Carolina at Chapel Hill.
Location of Community College
Location of University Program
Source: North Carolina Community College System, 2004; University Programs, 2005.
no students enrolled for past three years. Enrollment data were unavailable for programs
at Lenoir- Rhyne College in Catawba County.
* Locations of community colleges and universities are mapped to the zip code centroid.
** Enrollment of each community college is mapped to the county where the community
college is located. Sampson CC and Craven CC have allied health programs, but no
Stokes
Surry
Yadkin
Iredell
Davie
Stanly
Union
Cabarrus
Rowan
Alamance
Davidson
Rockingham
Guilford
Chatham
Montgomery
Hoke
Moore
Lee
Randolph
Richmond
Scotland
Robeson
Vance
Caswell
Person
Granville
Durham
Orange
Wake
Harnett
Franklin
Cumberland
Bladen
Warren
Johnston
Sampson
Jones
Pender
Duplin
Onslow
Lenoir
Wayne
Greene
Wilson
Halifax
Nash
Edgecombe
Bertie
Pitt
Hertford
Northampton
Martin
Hyde
Beaufort
Craven
Pamlico
Carteret
Perquimans
Washington
Pasquotank
Chowan
Gates
Dare
Tyrrell
Anson
Columbus
Brunswick
New
Hanover
Cherokee
Clay
Graham
Swain
Macon
Haywood
Madison
Transylvania
Jackson
Mitchell
Yancey
Polk
Henderson
Buncombe
Avery
McDowell
Rutherford
Watauga
Caldwell
Ashe
Wilkes
Alleghany
Alexander
Lincoln
Gaston
Catawba
Cleveland
Burke
Mecklenburg
Forsyth
crease as the population ages because utilization
of services typically increases with age. Thus,
communities with a high proportion of older
residents are more likely to experience increased
demand for health care services over time. ( Fig-ure
13)
The increase in health care demand will cre-ate
significant economic development opportu-nities
within the state— both due to the aging of
baby boomers already living in North Carolina
and to the influx of new residents. In 2004, 17
North Carolina counties were designated as “ re-tirement
destinations” by the U. S. Department
of Agriculture’s Economic Research Service.
Avery County, in northwest North Carolina,
has seen a rapid growth in health care employ-ment
to fill demand for health care and related
services. Cannon Memorial Hospital is Avery
County’s largest employer, with more than 500
employees.
In retirement communities, the flow of
Medicare and other health care expenditures
to providers have an important impact on local
jobs and health revenue. Health care expendi-tures
by Medicare, Medicaid, and other payers
are distributed to health care providers ( e. g.,
hospitals, physicians, clinics, pharmacies) in
exchange for medical services provided. For ex-ample,
in 2004 North Carolina spent more than
$ 6.8 billion in federally funded Medicare expen-ditures.
These funds represent a major source
of revenue for health care providers and are a
key factor in funding health care jobs. Using the
Avery County example, Cannon Memorial Hos-pital
attributes more than 70% of its inpatient
revenue to Medicare.
North Carolina’s temperate climate and ac-cess
to recreation have been key factors in the
state becoming a magnet for retirees. Yet to
realize the economic development potential
created by the influx of retirees, the state must
maintain and further develop a strong health
care infrastructure.
What’s Needed: Coordination
Allied health employment in North Carolina is
expected to increase, and the state faces high va-cancy
rates in some professions. Vacancy rates are
Figure 12
Location of Allied Health Programs* and Total Enrollment in Allied
Health Programs, North Carolina Community Colleges and University
Programs, 2004
Source: North Carolina Community College System, 2004; University Programs, 2005. Produced by: The North Carolina Health
Professions Data System, Cecil G. Sheps Center for Health Services Research, Thu University of North Carolina at Chapel Hill.
Notes: Locations of community colleges and universities are mapped to the zip code centroid. Enrollment of each community
college is mapped to the county where the community college is located. Sampson CC and Craven CC have allied health
programs, but no students enrolled for past three years. Enrollment data were unavailable for the program at Lenoir- Rhyne
College in Catawba County.
C a r o l i n a c o n t e x t 7
generally higher in rural, eastern North Carolina.
Without coordinated action, allied health
workforce development efforts become frag-mented
because of limited collaboration be-tween
policy makers, employers, educators and
others charged with monitoring, planning and
implementing workforce strategies at the lo-cal
or state level. Workforce shortages are not
unique to individual employers or regions of the
state, and the responsibility for ameliorating
these shortages does not rest on the shoulders
of individual entities. Thus, policy interventions
aimed at coordinating a synergistic response has
the potential to yield high benefits.
Developing a well- coordinated allied health
infrastructure presents a number of challenges:
• Growth in the health services economy
has benefits as well as burdens. Relative to de-clining
manufacturing jobs, many entry- level
allied health jobs are low- paying and/ or don’t
come with benefits; higher paying jobs require
more extensive training.
• Many health jobs do not have opportu-nities
for career laddering. Opportunities to
promote workers from entry- level jobs ( i. e.
occupational therapy assistant positions) into
more advanced jobs ( occupational therapist
jobs) do not exist. An important challenge
that workforce and health care planners face
is creating opportunities for career laddering
from entry- level positions to these higher-skill,
higher- wage positions, which enable the
worker to continue working ( and earning
income) during the process.
Despite strong demand for allied health
workers, many educational programs are under-enrolled
or face a shortage of adequately pre-pared
applicants.
Attrition from education programs is a ma-jor
issue confronting the allied health workforce
and is costly both to the educational system and
students.
Faculty recruitment and retention issues
are common for most allied health professions,
particularly those facing shortages, because fac-ulty
salaries cannot compete with clinical sala-ries.
A related issue is that many allied health
professions are facing increased accreditation
standards that require faculty to hold advanced
degrees. While this change improves the quality
of faculty who are teaching future practitioners,
it also contributes to faculty shortages. Faculty
who do not want to pursue additional education
may instead choose to retire or return to clinical
practice. Faculty shortages constrict future sup-ply
by reducing the number of individuals able to
teach courses and supervise clinical placements.
Future Opportunities
Research has shown that investments in
educating allied health workers pay short- term
dividends because the vast majority of these
professionals are trained through the local com-munity
college system and they tend to stay in-state,
near to where they were trained. Thus,
the combination of strong growth rates in allied
health employment and high retention rates for
students creates opportunities for state policy
makers to increase access to employment and
improve access to health care services across the
state, particularly in rural areas. Another ben-efit
from developing a more comprehensive and
concerted connection between economic devel-opment
and workforce development strategies
is the potential to help workers who have been
displaced from traditional industries into allied
health care employment. To accomplish this
goal, the following issues must be addressed:
• Create opportunities for better collabo-ration
between health workforce entities ( i. e.
the educational system, professional associa-tions,
employers) and workforce development
boards
• Target specific health care professions
and/ or regions of the state for allied health
workforce development
• Identify “ best practices”— support and
duplicate statewide:
Innovative programs to reduce attrition
from community college programs
Distance learning and multi- institution
collaborative educational programs
Career laddering opportunities: i. e.
articulation agreements and collabora-tion
between certificate, two- year and
four- year educational programs.
• Improve data collection efforts on the al-lied
health workforce so that we have a better
understanding of where existing and future
shortages exist.
•
•
•
Figure 13
Ambulatory Care Visits to Physician Offices and Clinics
per 100 Persons, United States, 2004
Source: NAMCS, 2004. Advance Data No. 374, June 23, 2006.
Note: Visit rates for age, sex, race, and ethnicity are based on the July 1, 2004, set of estimates of the
civilian noninstitutional population of the United States as developed by the Population Division, U. S.
Census Bureau.
800
700
600
500
400
300
200
100
0
1- 4 years 5- 14 years 15- 24 years 25- 44 years 45- 64 years 65- 74 years 75 years
or older
Visits per 100 persons per year
278.3 187.1 173.8 238.6 378.2 622.6 733.8
Age
Total Visits= 810,867;
316.8 visits per 100
persons